Individual
PRIIT JAAGOSILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1116 N 16TH ST, SUITE A, LAFAYETTE, IN 47904-2119
(765) 448-8000
(765) 448-8054
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01054247A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000351161
ANTHEM PROVIDER NUMBER
IN
01
—
11438153
CAQH NUMBER
IN
05
—
20049990
—
IN
01
—
9397183
PHCS PID NUMBER
IN
Enumeration date
03/15/2006
Last updated
01/14/2021
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